Abstract OBJECTIVE: The primary purpose of this study was to provide insight into the central changes that occur in amyotrophic lateral sclerosis (ALS) with a view to understanding how these could contribute to symptoms. MATERIAL AND METHODS: Seventeen patients with definite ALS and 17 control healthy volunteers were included in the study. Clinical examination, amyotrophic lateral sclerosis severity score (ALSSS) and TMS investigations including measurement of resting and active motor threshold (RMT and AMT), motor evoked potential (MEP), input-output curve, contralateral silent period, and transcallosal inhibition (CSP and TI, postulated markers of GABAb function) were measured for each participant. RESULTS: There were no significant differences in RMT or AMT in either hemisphere between patients and the control group. Despite this there was a significant negative correlation between ALSSS and RMT and AMT meaning that increased severity was associated with higher thresholds. MEPs were significantly smaller in ALS patients in comparison to the control group (P = 0.03). There was a significant decrease in the slope of the I/O relationship of MEP amplitude to TMS intensity in patients group in comparison to controls. ALS patients had a significant prolongation of CSP and TI for both hemispheres. There was a tendency for a significant negative correlation between left TI and ALSSS (P = 0.051). CONCLUSION: Measurements of cortical motor excitatory changes in ALS confirm the presence of corticospinal hypoexcitability. Additionally we found increased excitability of presumed intracortical GABAb circuits that correlated with the severity of ALS. We postulate that the disease results in an imbalance between excitation and inhibition in the cortex that can contribute to clinical symptoms.

Abstract OBJECTIVE: The primary purpose of this study was to provide insight into the central changes that occur in amyotrophic lateral sclerosis (ALS) with a view to understanding how these could contribute to symptoms. MATERIAL AND METHODS: Seventeen patients with definite ALS and 17 control healthy volunteers were included in the study. Clinical examination, amyotrophic lateral sclerosis severity score (ALSSS) and TMS investigations including measurement of resting and active motor threshold (RMT and AMT), motor evoked potential (MEP), input-output curve, contralateral silent period, and transcallosal inhibition (CSP and TI, postulated markers of GABAb function) were measured for each participant. RESULTS: There were no significant differences in RMT or AMT in either hemisphere between patients and the control group. Despite this there was a significant negative correlation between ALSSS and RMT and AMT meaning that increased severity was associated with higher thresholds. MEPs were significantly smaller in ALS patients in comparison to the control group (P = 0.03). There was a significant decrease in the slope of the I/O relationship of MEP amplitude to TMS intensity in patients group in comparison to controls. ALS patients had a significant prolongation of CSP and TI for both hemispheres. There was a tendency for a significant negative correlation between left TI and ALSSS (P = 0.051). CONCLUSION: Measurements of cortical motor excitatory changes in ALS confirm the presence of corticospinal hypoexcitability. Additionally we found increased excitability of presumed intracortical GABAb circuits that correlated with the severity of ALS. We postulate that the disease results in an imbalance between excitation and inhibition in the cortex that can contribute to clinical symptoms.

Abstract INTRODUCTION: In Alzheimer's disease (AD), transcranial magnetic stimulation (TMS) studies have been limited to test motor cortical excitability. The aim of this study was to investigate the inhibitory circuits of the motor cortex and to relate these to measures of cognitive function in AD patients. Results were compared with those of a control group of healthy subjects matched for age, sex and education. PATIENTS AND METHODS: Forty-five AD patients and 37 healthy volunteers were included in the study. Each participant received a neurological evaluation, Mini-Mental State Examination (MMSE), and Clinical Dementia Rating (CDR). Neurophysiological evaluations included resting and active motor threshold (rMT and aMT), motor evoked potential (MEP), cortical silent period (CSP), and transcallosal inhibition (TI). RESULTS: AD patients showed significantly reduced rMT, aMT and shorter MEP onset latency; in addition there was a prolongation of both CSP and TI. There was a significant positive correlation between the MMSE and CDR, on the one hand, and aMT and rMT, on the other hand, whereas the correlation was negative with CSP and TI durations. CONCLUSION: AD is associated with hyperexcitability of the motor cortex, which supports the hypothesis that changes in GABAb and glutamate function are important factors in cognitive impairment.

Abstract INTRODUCTION: In Alzheimer's disease (AD), transcranial magnetic stimulation (TMS) studies have been limited to test motor cortical excitability. The aim of this study was to investigate the inhibitory circuits of the motor cortex and to relate these to measures of cognitive function in AD patients. Results were compared with those of a control group of healthy subjects matched for age, sex and education. PATIENTS AND METHODS: Forty-five AD patients and 37 healthy volunteers were included in the study. Each participant received a neurological evaluation, Mini-Mental State Examination (MMSE), and Clinical Dementia Rating (CDR). Neurophysiological evaluations included resting and active motor threshold (rMT and aMT), motor evoked potential (MEP), cortical silent period (CSP), and transcallosal inhibition (TI). RESULTS: AD patients showed significantly reduced rMT, aMT and shorter MEP onset latency; in addition there was a prolongation of both CSP and TI. There was a significant positive correlation between the MMSE and CDR, on the one hand, and aMT and rMT, on the other hand, whereas the correlation was negative with CSP and TI durations. CONCLUSION: AD is associated with hyperexcitability of the motor cortex, which supports the hypothesis that changes in GABAb and glutamate function are important factors in cognitive impairment.

Abstract INTRODUCTION: In Alzheimer's disease (AD), transcranial magnetic stimulation (TMS) studies have been limited to test motor cortical excitability. The aim of this study was to investigate the inhibitory circuits of the motor cortex and to relate these to measures of cognitive function in AD patients. Results were compared with those of a control group of healthy subjects matched for age, sex and education. PATIENTS AND METHODS: Forty-five AD patients and 37 healthy volunteers were included in the study. Each participant received a neurological evaluation, Mini-Mental State Examination (MMSE), and Clinical Dementia Rating (CDR). Neurophysiological evaluations included resting and active motor threshold (rMT and aMT), motor evoked potential (MEP), cortical silent period (CSP), and transcallosal inhibition (TI). RESULTS: AD patients showed significantly reduced rMT, aMT and shorter MEP onset latency; in addition there was a prolongation of both CSP and TI. There was a significant positive correlation between the MMSE and CDR, on the one hand, and aMT and rMT, on the other hand, whereas the correlation was negative with CSP and TI durations. CONCLUSION: AD is associated with hyperexcitability of the motor cortex, which supports the hypothesis that changes in GABAb and glutamate function are important factors in cognitive impairment.

Abstract INTRODUCTION: In Alzheimer's disease (AD), transcranial magnetic stimulation (TMS) studies have been limited to test motor cortical excitability. The aim of this study was to investigate the inhibitory circuits of the motor cortex and to relate these to measures of cognitive function in AD patients. Results were compared with those of a control group of healthy subjects matched for age, sex and education. PATIENTS AND METHODS: Forty-five AD patients and 37 healthy volunteers were included in the study. Each participant received a neurological evaluation, Mini-Mental State Examination (MMSE), and Clinical Dementia Rating (CDR). Neurophysiological evaluations included resting and active motor threshold (rMT and aMT), motor evoked potential (MEP), cortical silent period (CSP), and transcallosal inhibition (TI). RESULTS: AD patients showed significantly reduced rMT, aMT and shorter MEP onset latency; in addition there was a prolongation of both CSP and TI. There was a significant positive correlation between the MMSE and CDR, on the one hand, and aMT and rMT, on the other hand, whereas the correlation was negative with CSP and TI durations. CONCLUSION: AD is associated with hyperexcitability of the motor cortex, which supports the hypothesis that changes in GABAb and glutamate function are important factors in cognitive impairment.

In the field of cardiovascular disease, troponins have emerged as the most reliable clinical measure of myocyte injury. Despite the widespread use of cardiac troponins as biomarkers for diagnosis and risk stratification, their condition in cardiomyopathy are not known. Patients and methods: The study was conducted on 20 children with dilated cardiomyopathy, attending the Cardiology Unit of Assiut University Children Hospital, for recurring episodes of heart failure. Determination of serum level of cardiac troponin T was done on admission and discharge after relief of presenting symptoms. Results: Serum cardiac troponin T concentrations were normal ( below the lower detection limit which is 0.01 ng/ml) on admission and on discharge. Conclusion: Serum cardiac troponin T does not increase in dilated cardiomyopathy.

In the field of cardiovascular disease, troponins have emerged as the most reliable clinical measure of myocyte injury. Despite the widespread use of cardiac troponins as biomarkers for diagnosis and risk stratification, their condition in cardiomyopathy are not known. Patients and methods: The study was conducted on 20 children with dilated cardiomyopathy, attending the Cardiology Unit of Assiut University Children Hospital, for recurring episodes of heart failure. Determination of serum level of cardiac troponin T was done on admission and discharge after relief of presenting symptoms. Results: Serum cardiac troponin T concentrations were normal ( below the lower detection limit which is 0.01 ng/ml) on admission and on discharge. Conclusion: Serum cardiac troponin T does not increase in dilated cardiomyopathy.

Repetitive transcranial magnetic stimulation (rTMS) has become widely used as a therapeutic tool in psychiatric research. Theaim of this study was to evaluate the impact of different frequencies of rTMS over right dorsolateral prefrontal cortex (DLPFC) in OCD. Forty five patients with OCD participated in the study. Patients were evaluated using: Yale-Brown obsessive compulsive scale (Y-BOCS), Hamilton Anxiety Rating Scale (HAM-A), and Clinical Global Impression-Severity scale (CGI-S). They were randomly classified into three groups: 1st group received 1 Hz rTMS; 2nd group received 10 Hz rTMS; and 3rd group received sham stimulation all at 100% of the resting motor threshold for 10 sessions. They were followed up after the last treatment session and 3 months later. There was a significant “time”
“group” interaction for 1 Hz versus Sham but not for 10 Hz versus Sham. 1 Hz versus 10 Hz groups showed a significant interaction for Y-BOCS and HAM-A (P¼0.001 and 0.0001 respectively). 1 Hz rTMS has a greater clinical benefit than 10 Hz or Sham. There was also a significantly larger percentage change in GCI-S in the 1 Hz group versus either 10 Hz or sham. We conclude that 1 Hz-rTMS, targeting right DLPFC is a promising tool for treatment of OCD.

Repetitive transcranial magnetic stimulation (rTMS) has become widely used as a therapeutic tool in psychiatric research. Theaim of this study was to evaluate the impact of different frequencies of rTMS over right dorsolateral prefrontal cortex (DLPFC) in OCD. Forty five patients with OCD participated in the study. Patients were evaluated using: Yale-Brown obsessive compulsive scale (Y-BOCS), Hamilton Anxiety Rating Scale (HAM-A), and Clinical Global Impression-Severity scale (CGI-S). They were randomly classified into three groups: 1st group received 1 Hz rTMS; 2nd group received 10 Hz rTMS; and 3rd group received sham stimulation all at 100% of the resting motor threshold for 10 sessions. They were followed up after the last treatment session and 3 months later. There was a significant “time”
“group” interaction for 1 Hz versus Sham but not for 10 Hz versus Sham. 1 Hz versus 10 Hz groups showed a significant interaction for Y-BOCS and HAM-A (P¼0.001 and 0.0001 respectively). 1 Hz rTMS has a greater clinical benefit than 10 Hz or Sham. There was also a significantly larger percentage change in GCI-S in the 1 Hz group versus either 10 Hz or sham. We conclude that 1 Hz-rTMS, targeting right DLPFC is a promising tool for treatment of OCD.